TARGETED CASE MANAGEMENT

This amendment to the Medicaid State Plan implements a CMS-required preprint for describing targeted case management programs. The Division of Medicaid and Health Financing (DMHF) will amend Attachments 3.1-A and 3.1-B sections of the State Plan that describe targeted case management for individuals with mental illness to use the required preprint.

DMHF will also eliminate the section of the State Plan that has separately described targeted case management for individuals with substance use disorders. DMHF will incorporate this section into the revised Attachments 3.1-A and 3.1-B sections describing targeted case management for individuals with mental illness. DMHF will combine these sections of the State Plan as substance use disorders fall under the broad classification of mental illness; therefore, separate targeted case management sections in the State Plan are not necessary.

DMHF will also amend Attachment 4.19-B of the State Plan describing targeted case management for individuals with mental illness to remove outdated language. DMHF will also eliminate the Attachment 4.19-B section related to the targeted case management for individuals with substance use disorders.

DMHF does not anticipate an increase or decrease in annual expenditures to result from these changes as the changes maintain previous coverage and payment levels.

This proposed change, if approved, becomes effective on January 1, 2013.

A copy of this change may be obtained from Craig Devashrayee (801-538-6641), or by writing the Technical Writing Unit, Utah Department of Health, PO Box 143102, Salt Lake City, UT 84114-3102. Comments are welcome at the same address. Copies of the change are also available at local county health department offices.

REHABILITATIVE MENTAL HEALTH AND SUBSTANCE USE DISORDER SERVICES

The Division of Medicaid and Health Financing (DMHF) is amending Attachments 3.1-A and 3.1-B of the Medicaid State Plan to include rehabilitative mental health services, rehabilitative substance use disorder services, rehabilitative mental health and substance use disorder services for individuals eligible for Medicaid under the Early and Periodic Screening, Diagnosis and Treatment Program (EPSDT), and peer support services, in one section, whereas currently they are in four separate sections of the State Plan.

The Centers for Medicare and Medicaid Services (CMS) has requested that the State Plan contain one section describing rehabilitative behavioral health services. This consolidation will satisfy that request.

DMHF will also eliminate the Attachment 4.19-B sections that are no longer necessary due to the consolidation. DMHF will amend the remaining Attachment 4.19-B sections to remove outdated language, and to address the deletion of the Current Procedural Terminology (CPT) code for psychiatric pharmacologic management that is effective January 1, 2013, due to changes published in the 2013 edition of the CPT manual. Pending CMS approval of this amendment, providers may be paid for select established patient evaluation and management (E&M) codes at the rate that was in effect for psychiatric pharmacologic management on December 31, 2012.

DMHF does not anticipate an increase in annual expenditures to result from these changes as they maintain previous coverage and payment levels.

This proposed change, if approved, becomes effective on January 1, 2013.

A copy of this change may be obtained from Craig Devashrayee (801-538-6641), or by writing the Technical Writing Unit, Utah Department of Health, PO Box 143102, Salt Lake City, UT 84114-3102. Comments are welcome at the same address. Copies of the change are also available at local county health department offices.

PHYSICIAN SERVICES

The Division of Medicaid and Health Financing (DMHF) will submit an amendment to Attachment 4.19-B of the Medicaid State Plan for physician services to address the deletion of the Current Procedural Terminology (CPT) code for psychiatric pharmacologic management that is effective January 1, 2013, due to changes published in the 2013 edition of the CPT manual. Pending CMS approval of this amendment, providers may be paid for select established patient evaluation and management (E&M) codes at the rate that was in effect for psychiatric pharmacologic management on December 31, 2012.

DMHF does not anticipate an increase in annual expenditures to result from these changes as they maintain previous coverage and payment levels.

This proposed change, if approved, becomes effective on January 1, 2013.

A copy of this change may be obtained from Craig Devashrayee (801-538-6641), or by writing the Technical Writing Unit, Utah Department of Health, PO Box 143102, Salt Lake City, UT 84114-3102. Comments are welcome at the same address. Copies of the change are also available at local county health department offices.